Ralf Schwarzer & Reinhard Fuchs
Freie Universität Berlin
Conner, M., & Norman, P. (1995). Predicting Health Behaviour: Research and Practice with Social Cognition Models (pp. 163-196). Buckingham: Open University Press.
To avoid copyright violation, the major part of this paper has been cut.
1.0 General Background
Self-referent thought has become an issue that pervades psychological research in many domains. In 1977, the famous psychologist Albert Bandura at Stanford University introduced the concept of perceived self-efficacy in the context of cognitive behaviour modification. It has been found that a strong sense of personal efficacy is related to better health, higher achievement, and more social integration. This concept has been applied to such diverse areas as school achievement, emotional disorders, mental and physical health, career choice, and sociopolitical change. It has become a key variable in clinical, educational, social, developmental, health, and personality psychology. The present chapter refers to its influence on the adoption, initiation, and maintenance of health behaviours. It represents the key construct in Social Cognitive Theory (Bandura, 1977, 1986, 1991, 1992).
5.0 Operationalization of the Model
The three major cognitions that operate during the motivation phase can be assessed by single items such as the following:
It is of note that the first kind of cognition, risk perception, need not be the same as threat experience, and the relationship between the two still awaits theoretical and empirical elaboration. To make test construction simple, one can keep in mind that outcome expectancies are best worded with if-then statements, and self-efficacy items as confidence-statements. The semantic structure of outcome expectancies are:
For self-efficacy the corresponding wording could be:
This rule need not be applied rigidly, but should serve as a heuristic. It is suggested to assess a variety of outcome expectancies, including positive and negative ones. People have many reasons why they should quit smoking or why they find it better to continue. The test items should cover the scope of pros and cons that an individual balances. It is also suggested not to present different constructs neatly separated in the questionnaire, but rather to scramble them so that the respondents don't realize at first glance what this is all about.
However, there is no way to determine the reliability of single items, and therefore one might want to consider using psychometric scales that consist of a number of items. These scales are, of course, less economical, but they often help to assure that the theoretical constructs are tapped by the sum score and that they are measured more reliably. Self-efficacy scales that are more or less adequate have been published for all kinds of health behaviours.
Various psychometric instruments have been developed to assess self-efficacy for physical activities, such as the Diving Efficacy Scale by Feltz, Landers and Raeder (1979), the Physical Self-Efficacy Scale by Ryckman, Robbins, Thornton and Cantrell (1982), the Exercise Self-Efficacy Scale by Garcia and King (1991), and others (Barling & Abel, 1983; Fruin, Pratt & Owen, 1991; Fuchs & Schwarzer, 1994; Godin, Valois & Lepage, 1993; Marcus & Owen, 1992; Woolfolk, Murphy, Gottesfeld & Aitken, 1985). Physical exercise self-efficacy scales for patients coping with chronic disease were designed by Holman and Lorig (1992) and Toshima, Kaplan and Ries (1992).
In the field of nutrition and weight control, Stotland, Zuroff and Roy (1991) came up with a "Situation-Based Dieting Self-Efficacy Scale" that presents 25 risk situations and measures adherence to a diet in these situations. Clark, Abrams, Niaura, Eaton and Rossi (1991) devised a 20-item "Weight Efficacy Life-Style Questionnaire" with five situational factors, namely negative emotions, availability of foods, social pressure, physical discomfort, and positive activities.
There are two basic methods to design a risk-behaviour self-efficacy scale. One is to confront the individual with a list or hierarchy of tempting situations and to assess situation-specific self-efficacy in line with these demands. The second approach aims at the restricted use of substances, asking subjects whether in general they feel competent to control the behaviour in question (irrespective of specific risk situations). In the domain of smoking, for example, the first method has been chosen by Colletti et al. (1985), and Velicer et al. (1990). In research on drinking, it has been preferred by Annis (1982), Annis and Davis (1988), DiClemente at al. (1985), and Miller, Ross, Emmerson and Todt (1989). The second approach was chosen by Godding and Glasgow (1985), for example, to assess smoking self-efficacy. For alcohol consumption, instruments were presented by Rychtarik, Prue, Rapp and King (1992), Sitharthan and Kavanagh (1990), and Young, Oei and Crook (1991). A third attempt to assess self-efficacy has been published by Haaga and Stewart (1992), who developed an "articulated thoughts technique" to measure recovery self-efficacy after a setback from smoking abstinence.
Scales for self-efficacy for smoking, dieting, physical exercise, condom use, cancer screening, and social support provision can be found in Schwarzer (1993). These scales are available in English, Spanish, and German. A generalized self-efficacy scale is available in more languages.
In addition to the assessment of risk perception, outcome expectancies, and self-efficacy, it is essential to identify the individual's motivation stage. A unique way to arrive at some idea about one's stage is given by a single-item self-report measure, the "contemplation ladder" (Biener & Abrams, 1991).
Inconsistency in research findings is partly due to heterogeneous designs of the assessment methods. The present recommendations might help to standardize the construction rationales, but not the inventories themselves.
The Contemplation Ladder
Each rung on this ladder represents where various smokers are in their thinking about quitting. Circle the number that indicates where you are now.
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